Family Medicine / Direct Primary Care / Walk-Ins

The Day the Squirrel(s) Went Berserk

I once knew a fellow who was fond of saying, "Two is one and one is none." Basically, he was saying that you should always have a backup. In this world where we are increasingly dependent on computers, databases, networks, and wireless communication, it becomes even more of an imperative.

Mississippi squirrel

15 years ago, most doctors’ offices used paper charts exclusively. Progress notes, orders, prescriptions, and the bill were all presented on paper. Fast forward to 2018, paper is becoming increasingly scarce as offices upgrade to electronic medical records and strive toward the ideal of a paperless office. Now the funny thing about the electronic medical record is that it initially created more paper usage since early adopters found they still had to print everything to communicate with the outside world, but now that electronic records have reached critical mass, it is easier to operate entirely without paper.

The cost of most electronic record systems is exorbitant. A major hospital EMR system such as Cerner, whose implementation I had the privilege of overseeing as Chief Medical Information Officer at St Dominic Hospital, can cost tens of millions of dollars. Even most small office systems can cost several thousand dollars a year per physician. But paper has its own expense too. The cost of toner cartridges, bulk paper, chart storage, and the inefficiencies of managing paper records can add up quite fast. With that in mind, Face Value Health DPC was determined to run as close to paperless as possible. First, we adopted a flexible, nimble electronic medical record system designed exclusively for direct primary care: Atlas.MD. This system is a secure cloud-based system with unlimited storage for charts and scanned documents. It manages my medication dispensing system, laboratory ordering and results, and virtually automates the billing system. As our patients know, Face Value Health DPC operates with only 2 full-time employees, nurse Nichole and myself. We benefit (and so do our patients) when we automate as many functions as possible because it keeps our costs and your prices low.

Obviously, it is critical that we have internet access to Atlas.MD at all times if we are going to fulfill our promises to you our patients. In keeping with the "two is one and one is none" mantra, we had to develop a contingency plan in the unlikely situation that we were without broadband internet access. For nearly the first three months of business, Face Value Health DPC had flawless performance from its communication network, but one can never be too complacent. And then, it happened. I stopped by the office on Saturday, August 25th, to put the garbage cans up and I took a moment to pull up Atlas.MD to check a few results. Instead, I got a warning box stating that there was no broadband internet access. I then looked at the screen on one of our phones and it said "No Line." Our clinic uses VoIP (voice over Internet Protocol) rather than traditional phone service, so our phone lines and our internet all originate from one router. Rather than green, all status lights were red. Immediately, I recalled that my neighbor who uses the same internet service provider had the same issue with complete loss of service about two weeks earlier. It took them almost four days to get their service back and with that thought, I had a sinking feeling in the pit of my stomach. For just a brief moment, I worried about the distinct possibility that I would have no service at all when I stepped into the office Monday to see patients.

But we had our contingency plan! First, we had a special router that worked off of the wireless cellular network. With probably the most massive cell tower in the entire area just a few hundred feet away, we were guaranteed an exceptional signal. I pointed every computer to the back up wireless router and tested our scanning, printing, and prescription system and everything worked flawlessly except faxing. Now for the phones: Our system allowed us to log on to our service provider’s website and redirect our telephones to our cell phones in case there was service failure. Unfortunately, this site was not functioning properly. I had to make at least three calls to find someone who understood what I was referring to and fortunately the last person person was able to get it working again by the next morning. It was looking more and more like I would have to depend on that back-up plan since our service provider was unable to get a technician out until late Monday. So Monday morning, we began in earnest without our primary phone and internet service, but we managed to make it work. The technician arrived later that afternoon, checked everything out, and diagnosed some bad lines between our location and 150 yards north of us towards City Hall. He informed us it would take an engineer to fix it and that he would be at our location tomorrow. Day #2: Once again, we were working with our back-up plan but other than faxing, we were doing quite well. The engineer arrived before noon and informed us that he had found several bad lines. In fact after checking them, he was surprised we ever had satisfactory service at all. He was able to run some new lines and our service was restored by Tuesday afternoon. Eureka! So things appeared to be back to normal, that is until we arrived the following Wednesday morning. Once again, everything was down and I was beginning to get a bit frustrated. And again, I switched everything back over to the backup router, forwarded all of the office calls to our cell phones, and got back on the phone with our service provider. I was promised an early technician visit, but two hours after the window, no one showed. I made another call closer to noon and was immediately transferred to the "Escalation Center," which sounded like something scary out of a George Orwell novel. There, I met a supervisor who was not very pleasant and a bit confrontational. You see, the technician and the engineer previously had verbally given me a full description of what they had found but when it came to documenting it, they kept it short and sweet. The supervisor was in no mood to hear my report but rather insisted that he “had the documentation” which implied that the problem was inside my building, which would have been my responsibility. If you, dear reader, have ever had something documented in your medical record that was incorrect then you may have an idea how I felt at this time. Somehow, we got through his resistance and I made it clear we had to get someone out here to fix it ASAP. So at 4 that afternoon, another engineer arrived. He checked the system and noted that the problem was once again outside of our building. About an hour later he was back and told me he fixed the problem. Then he proceeded to show me a video on his phone. In the relay box, there was not one but two squirrels having quite a good time making a mess of our communications system! As I reflected back on the whole experience, I was reminded of that humorous Ray Stevens song from years ago, "The Mississippi Squirrel Revival" with its infectious refrain, "The day the squirrel went berzerk." Let's just say, I was very glad that we had that contingency plan!

You see, we can't afford to accept delays and failures when we're trying to provide the best primary care in Ridgeland. When you need us, it is imperative that we are able to meet the charge. If we become dependent on any one method of doing things, then we set ourselves up for failure. We can all learn a lesson from those crazed Mississippi squirrels: Never let circumstances make the decision for you. Consider areas in your life where failure is not an option and meet the challenge head-on by creating a contingency plan. An advance directive, where you express your health care wishes if you are incapacitated and unable to make decisions, is one example. Don't let that decision be forced onto your children when emotions are running high. And don't let a team of medical professionals make that decision by default. Consider what is important to you and put it in writing. Have a will so your estate doesn't end up in probate waiting on the slow moving gears of government to sort things out.

Although nobody expects bad things to happen, life will always throw curve balls at us when we least expect it. It is never “if”, but always “when”. Murphy's Law is called a law and not a suggestion for a reason. And denial is NOT a river a in Egypt!

The Nile River, not Denial River

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Face Value Health DPC is a unique direct primary care practice in Ridgeland, MS that combines exceptional value and affordability with unbeatable quality, attention, and access to primary care. We are perfect for anybody desiring a better primary care experience, for small business owners and their employees, and for people with high deductibles or no insurance. Call us at (601)790-7105 to schedule your appointment and experience a different, better approach to primary care.

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